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Kar E, Ammanamanchi A, Yousif M, Geetha SD, Schwartz K, Mishra AS, Ling J, Nonyelu KN, Kannadath BS. From bimodal to unimodal: The transformed incidence of osteosarcoma in the United States. J Bone Oncol 2024; 47:100613. [PMID: 38975333 PMCID: PMC11225682 DOI: 10.1016/j.jbo.2024.100613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 06/02/2024] [Accepted: 06/03/2024] [Indexed: 07/09/2024] Open
Abstract
Background Osteosarcoma is the most common primary bone malignancy. It has classically been described as having a bimodal incidence by age. We sought to identify whether the bimodal incidence distribution still exists for osteosarcoma using the SEER and NIS databases. Methods Incidence rates of primary osteosarcoma between 2000-2021 were analyzed by age at diagnosis, year of occurrence, sex, and tumor site from the SEER Research Data, 17 Registries, Nov 2023 Sub (2000-2021). The incidence of cases in 35-64 year-olds and 65 and above was compared statistically to determine if there is an increased incidence in the later ages. Incidence of tumors of the long bones of the lower limbs from the NIS discharge database 2012-2019 was also analyzed for comparison. Results Overall, 5,129 cases of osteosarcoma were reported in the SEER database. Across the 22 calendar year span, a consistent first peak appeared in the second decade of life. There was no consistent second peak in the 35+ age group. There were 86,100 discharges with long bone tumors analyzed in the NIS data which exhibited nearly identical patterns. Conclusions Our analysis shows that the incidence of osteosarcoma is no longer bimodally distributed but rather unimodally distributed.
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Affiliation(s)
- Emma Kar
- The University of Arizona College of Medicine – Phoenix, Phoenix, AZ, United States
| | - Amrit Ammanamanchi
- The University of Arizona College of Medicine – Phoenix, Phoenix, AZ, United States
- The George Washington University Law School, Washington, D.C., United States
| | - Miranda Yousif
- The University of Arizona College of Medicine – Phoenix, Phoenix, AZ, United States
| | - Saroja Devi Geetha
- Northwell Health - Long Island Jewish Medical Centre and North Shore University Hospital, Queens, NY, United States
| | - Kendall Schwartz
- The University of Arizona College of Medicine – Phoenix, Phoenix, AZ, United States
| | - Arya Suman Mishra
- Royal Derby Hospital – Department of Trauma and Orthopaedics, Derby, England
| | - Jiali Ling
- The University of Arizona College of Medicine – Phoenix, Phoenix, AZ, United States
| | | | - Bijun Sai Kannadath
- The University of Arizona College of Medicine – Phoenix, Phoenix, AZ, United States
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Price A, File C, Call-Orellana F, Andrade de Almeida RA, North RY. Surgical decompression in spinal Paget's disease: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 8:CASE24203. [PMID: 39038367 DOI: 10.3171/case24203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/18/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Paget's disease of bone (PDB) is a common bone metabolic pathology in older adults, characterized by mixed osteolytic, osteoblastic, and quiescent periods. Surgical guidelines for PDB involving the spine are not well-defined and are reserved for cases refractory to medical treatments, typically bisphosphonates like zoledronic acid. This case study describes a 52-year-old male with PDB who presented with rapidly progressing myelopathy symptoms refractory to standard medical treatment, warranting surgical decompression. OBSERVATIONS Surgical decompression and fusion, involving laminectomy with partial facetectomies, placement of pedicle screw instrumentation, and posterolateral arthrodesis spanning beyond the pathological segment, was performed. Follow-up visits indicated progressive improvement in symptoms and mobility, and imaging showed stable postsurgical changes with increased sclerosis in the affected vertebrae on a 2-year postsurgical course. LESSONS This case underscores that PDB of the spine can transition from asymptomatic to significant impairment and demonstrates that surgical intervention can provide effective symptomatic relief in myelopathy secondary to PDB. The case contributes to the growing evidence of the effectiveness of surgical decompression in PDB involving the spine. https://thejns.org/doi/10.3171/CASE24203.
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Affiliation(s)
- Anthony Price
- John Sealy School of Medicine, The University of Texas Medical Branch at Galveston, Texas
- Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Texas
| | - Christopher File
- John Sealy School of Medicine, The University of Texas Medical Branch at Galveston, Texas
- Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Texas
| | - Francisco Call-Orellana
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Robert Y North
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Urquiaga M, Gaffo A. Paget disease of bone in a southeastern Veteran population. Am J Med Sci 2024; 367:357-362. [PMID: 38364993 DOI: 10.1016/j.amjms.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Paget disease of bone (PDB) is a disorder of accelerated bone remodeling resulting in bone overgrowth and impaired integrity that traditionally is described to be more frequent in individuals of European descent. Based on clinical observation, we hypothesized that among the US Southeastern Veteran population, the disease is more common among African American patients. MATERIALS AND METHODS We conducted a cross-sectional study using the Veterans Affairs' Clinical Data Warehouse (CDW) and review of electronic medical records (EMR). Using the CDW, we identified patients from the Birmingham VA Medical Center (BVAMC) with an International Classification of Diseases code for PDB between January 2000 and December 2020. We extracted their self-reported race from the CDW and determined the proportion of African American patients, which we compared to the proportion of White patients. As a secondary goal, we extracted relevant clinical characteristics from the EMR. The statistical analysis was done using Stata/SE 14.2 for Mac. RESULTS We identified 285 individuals from the BVAMC with PDB between January 2000 and December 2020. The proportion of African American patients was significantly higher than White patients (0.51 vs. 0.4, p = 0.0036). African American patients presented at a younger age than their peers (mean[standard deviation] age at diagnosis: 64.6[11.6] vs. 70.1[10.7] years, p = 0.0009) but did not have higher alkaline phosphatase levels, higher proportion of polyostotic disease, or of symptoms and complications. CONCLUSIONS In the BVAMC population, PDB is more common among African American patients than White patients. Our findings and other publications hint at the existence of a cluster of PDB among the African American population in the US Southeast.
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Affiliation(s)
- Mariana Urquiaga
- Birmingham VA Medical Center, Birmingham, Alabama, USA; Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Angelo Gaffo
- Birmingham VA Medical Center, Birmingham, Alabama, USA; Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Rendina D, Falchetti A, Diacinti D, Bertoldo F, Merlotti D, Giannini S, Cianferotti L, Girasole G, Di Monaco M, Gonnelli S, Malavolta N, Minisola S, Vescini F, Rossini M, Frediani B, Chiodini I, Asciutti F, Gennari L. Diagnosis and treatment of Paget's disease of bone: position paper from the Italian Society of Osteoporosis, Mineral Metabolism and Skeletal Diseases (SIOMMMS). J Endocrinol Invest 2024; 47:1335-1360. [PMID: 38488978 PMCID: PMC11142991 DOI: 10.1007/s40618-024-02318-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/18/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Paget's disease of bone is a focal skeletal disorder causing bone deformities and impairing bone quality. Despite the prevalence of asymptomatic cases is increasing, the progression of the disease can lead to invalidating complications that compromise the quality of life. Doubts on clinical and therapeutic management aspects exist, although beneficial effects of antiresorptive drugs, particularly bisphosphonates are known. However, limited information is available from randomized controlled trials on the prevention of disease complications so that somewhat contrasting positions about treatment indications between expert panels from the main scientific societies of metabolic bone diseases exist. This task force, composed by expert representatives appointed by the Italian Society of Osteoporosis, Mineral Metabolism and Skeletal Diseases and members of the Italian Association of Paget's disease of bone, felt the necessity for more specific and up to date indications for an early diagnosis and clinical management. METHODS Through selected key questions, we propose evidence-based recommendations for the diagnosis and treatment of the disease. In the lack of good evidence to support clear recommendations, available information from the literature together with expert opinion of the panel was used to provide suggestions for the clinical practice. RESULTS AND CONCLUSION Description of the evidence quality and support of the strength of the statements was provided on each of the selected key questions. The diagnosis of PDB should be mainly based on symptoms and the typical biochemical and radiological features. While treatment is mandatory to all the symptomatic cases at diagnosis, less evidence is available on treatment indications in asymptomatic as well as in previously treated patients in the presence of biochemical recurrence. However, given the safety and long-term efficacy of potent intravenous bisphosphonates such as zoledronate, a suggestion to treat most if not all cases at the time of diagnosis was released.
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Affiliation(s)
- D Rendina
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80138, Naples, Italy
| | - A Falchetti
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122, Milan, Italy
| | - D Diacinti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - F Bertoldo
- Emergency Medicine, Department of Medicine, University of Verona, 37129, Verona, Italy
| | - D Merlotti
- Department of Medical Sciences, Azienda Ospedaliera Universitaria Senese, 53100, Siena, Italy
| | - S Giannini
- Clinica Medica 1, Department of Medicine, University of Padova, 35122, Padua, Italy
| | - L Cianferotti
- Bone Metabolic Diseases Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, 50121, Florence, Italy
| | - G Girasole
- Rheumatology Department, La Colletta" Hospital, ASL 3 Genovese, 16011, Arenzano, Italy
| | - M Di Monaco
- Osteoporosis Research Center, Fondazione Opera San Camillo, Presidio Di Torino, 10131, Turin, Italy
| | - S Gonnelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy
| | - N Malavolta
- Casa Di Cura Madre Fortunata Toniolo, and Centri Medici Dyadea, 40141, Bologna, Italy
| | - S Minisola
- U.O.C. Medicina Interna A, Malattie Metaboliche Dell'Osso Ambulatorio Osteoporosi E Osteopatie Fragilizzanti, Sapienza University of Rome, 00185, Rome, Italy
| | - F Vescini
- Unit of Endocrinology and Metabolism, University-Hospital S. M. Misericordia, Udine, Italy
| | - M Rossini
- Rheumatology Unit, University of Verona, Policlinico GB Rossi, 37134, Verona, Italy
| | - B Frediani
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy
| | - I Chiodini
- Department of Biotechnology and Translational Medicine, University of Milan, 20122, Milan, Italy
- Ospedale Niguarda Cà Granda, Piazza Ospedale Maggiore 3, 20161, Milan, Italy
| | - F Asciutti
- Associazione Italiana Malati Osteodistrofia Di Paget, Siena, Italy
| | - L Gennari
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy.
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Hamel C, Avard B, Gorelik N, Heroux M, Mai D, Sheikh A, Vo A, Watson ML, Rakhra K. Canadian Association of Radiologists Musculoskeletal System Diagnostic Imaging Referral Guideline. Can Assoc Radiol J 2024; 75:269-278. [PMID: 37635274 DOI: 10.1177/08465371231190807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
The Canadian Association of Radiologists (CAR) Musculoskeletal System Expert Panel consists of musculoskeletal radiologists, a family physician, a sports and exercise medicine physician, emergency medicine physicians, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 25 musculoskeletal clinical/diagnostic scenarios, a systematic rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for 1 or more of these clinical/diagnostic scenarios. Recommendations from 41 guidelines (50 publications) and contextualization criteria in the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) for guidelines framework were used to develop 124 recommendation statements across the 25 scenarios related to the evaluation of the musculoskeletal system. This guideline presents the methods of development and the recommendations for imaging in the context of musculoskeletal pain, infection, tumors, arthropathies, metabolic bone disease, stress injuries, orthopedic hardware, avascular necrosis/bone infarction, and complex regional pain syndrome.
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Affiliation(s)
- Candyce Hamel
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Barb Avard
- North York General Hospital, Toronto, ON, Canada
| | - Natalia Gorelik
- Department of Radiology, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Adnan Sheikh
- Vancouver General Hospital, Vancouver, BC, Canada
| | | | | | - Kawan Rakhra
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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Briganti SI, Lanza O, Fioriti E, Leto G, Battisti S, Napoli N, Strollo R. Paget Disease of Bone Harboring Bone Metastatic Neuroendocrine Cancer: A Case Report. Calcif Tissue Int 2024; 114:550-553. [PMID: 38506956 DOI: 10.1007/s00223-024-01195-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/06/2024] [Indexed: 03/22/2024]
Abstract
In this case report, we describe an uncommon case of neuroendocrine cancer of unknown origin began with cauda equina syndrome in a patient affected by Paget disease of bone (PDB). A 76-year-old man with diagnosis of PDB, without history of pain or bone deformity, developed sudden severe low back pain. Bone alkaline phosphatase was increased and MRI and whole-body scintigraphy confirmed the localization of the disease at the third vertebra of the lumbar spine. Treatment with Neridronic Acid was started, but after only 2 weeks of therapy anuria and bowel occlusion occurred together with lower limb weakness and walking impairment. Cauda equina syndrome consequent to spinal stenosis at the level of L2-L3 was diagnosed after admission to Emergency Department and the patient underwent neurosurgery for spinal medulla decompression. The histologic results showed a complete subversion of bone structure in neoplastic tissue, consistent with metastatic neuroendocrine carcinoma of unknown origin. In conclusion, low back pain in the elderly may require deep investigation to individuate rare diseases. In asymptomatic patients with apparently stable PDB, the sudden appearance of pain or neurologic symptoms may alert the clinician for the possibility of other superimposing diseases, like bone metastases.
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Affiliation(s)
| | - Oreste Lanza
- Fondazione Policlinico Campus Bio-Medico di Roma, Rome, Italy
| | - Elvira Fioriti
- Fondazione Policlinico Campus Bio-Medico di Roma, Rome, Italy
| | - Gaetano Leto
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Sofia Battisti
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST), Dino Amadori", Meldola, FC, Italy
| | - Nicola Napoli
- Fondazione Policlinico Campus Bio-Medico di Roma, Rome, Italy
| | - Rocky Strollo
- Department of Endocrinology, Clinica Polispecialistica "Casa del Sole", Formia, LT, Italy.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Via Di Val Cannuta 247, 00166, Rome, Italy.
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Pinto CJ, Maldar SB, Hegde S, Choukimath SM. Radiological impact of oral bisphosphonate use on polyostotic Paget's disease of bone over a 2 year period. Radiol Case Rep 2024; 19:1886-1892. [PMID: 38434784 PMCID: PMC10905954 DOI: 10.1016/j.radcr.2024.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 03/05/2024] Open
Abstract
Paget's disease of bone is a disorder of osteoclasts which hampers the physiological process of bone remodeling. It is the most common metabolic orthopedic disease in the Caucasian populace; we report the diagnosis of Paget's disease of bone in a South-Asian male in his early 50s with a history of gastrointestinal symptoms, weight loss and back pain. An alkaline phosphatase level of 1104 IU/L was noted. A 3-phase bone scan showed noncontiguous heterogenous nuclear uptake. After exhaustive evaluation, the patient was diagnosed with Paget's disease of bone. Despite the disease activity being mitigated by alendronate and monitored by ALP levels within normal range per protocol, the patient had compression fractures of the vertebrae requiring early reinitiation of oral bisphosphonates. This raised doubts about the efficacy of metabolic marker-based management in Paget's disease of bone.
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Affiliation(s)
- Christopher Jude Pinto
- Department of Medicine, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
- Western Michigan University, Homer Stryker M.D School of Medicine, Battle Creek, MI, USA
| | - Shadab B. Maldar
- Department of Medicine, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Siddhi Hegde
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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Ayalon-Dangur I, Rudman Y, Tsvetov G, Slutzky-Shraga I, Akirov A, Shimon I, Hirsch D, Gorshtein A. Long-term effectiveness of zoledronic acid in patients with Paget's disease of bone - a retrospective cohort study. Endocrine 2024:10.1007/s12020-024-03791-7. [PMID: 38555314 DOI: 10.1007/s12020-024-03791-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/18/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE The aims of the current study were to describe clinical and biochemical features of patients with Paget disease of bone (PDB) followed at our medical center, and to examine the long-term effectiveness of zoledronate. METHODS Retrospective cohort study included consecutive patients≥18 years with a diagnosis of PDB, followed in the Rabin Medical Center (RMC) Institute of Endocrinology from 1973 to 2023. The cohort comprised two groups: patients treated/not treated with zoledronic acid (ZOL/NZOL). The primary outcome was the percentage of patients who achieved a biochemical therapeutic response. RESULTS Overall, 101 patients with PDB were included, 68 in the ZOL group and 33 in the NZOL group. The mean age was 65.2 ± 10.0 years, and 47% were female. Notably, 77% exhibited monostotic involvement, and only 3% had experienced fractures attributed to PDB. Mean ALP level at diagnosis was 160 ± 70.6 U/L. The median follow-up duration was 17 years since PDB diagnosis, comparable between the groups. Primary outcome was more prevalent in the ZOL compared to the NZOL group [42 patients (88%) VS 11 patients (52%) respectively, P = 0.004]. At the end of follow-up, mean ALP levels in the NZOL group were significantly higher than the levels in the ZOL group irrespective of the number of infusions received. CONCLUSION The majority of patients with PDB experience a mild disease course, marked by monostotic involvement and a low prevalence of fractures. Zoledronic acid effectively manages PDB, providing sustained biochemical response. The necessity for multiple zoledronic acid injections remains questionable, often implemented due to osteoporosis.
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Affiliation(s)
- Irit Ayalon-Dangur
- Institute of Endocrinology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Rudman
- Institute of Endocrinology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gloria Tsvetov
- Institute of Endocrinology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilana Slutzky-Shraga
- Institute of Endocrinology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Akirov
- Institute of Endocrinology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Shimon
- Institute of Endocrinology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dania Hirsch
- Institute of Endocrinology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Gorshtein
- Institute of Endocrinology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Columbres RCA, Din S, Gibbs L, Kimonis V. Bone scan findings of Paget's disease of bone in patients with VCP Multisystem Proteinopathy 1. Sci Rep 2024; 14:5917. [PMID: 38467645 PMCID: PMC10928154 DOI: 10.1038/s41598-024-54526-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/13/2024] [Indexed: 03/13/2024] Open
Abstract
Multisystem Proteinopathy 1 (MSP1) disease is a rare genetic disorder caused by mutations in the Valosin-Containing Protein (VCP) gene with clinical features of inclusion body myopathy (IBM), frontotemporal dementia (FTD), and Paget's disease of bone (PDB). We performed bone scan imaging in twelve patients (6 females, 6 males) with confirmed VCP gene mutation six (50%) of which has myopathy alone, four (33%) with both PDB and myopathy, and two (15%) were presymptomatic carriers. We aim to characterize the PDB in diagnosed individuals, and potentially identify PDB in the myopathy and presymptomatic groups. Interestingly, two patients with previously undiagnosed PDB had positive diagnostic findings on the bone scan and subsequent radiograph imaging. Among the individuals with PDB, increased radiotracer uptake of the affected bones were of typical distribution as seen in conventional PDB and those reported in other MSP1 cohorts which are the thoracic spine and ribs (75%), pelvis (75%), shoulder (75%) and calvarium (15%). Overall, we show that technetium-99m bone scans done at regular intervals are a sensitive screening tool in patients with MSP1 associated VCP variants at risk for PDB. However, diagnostic confirmation should be coupled with clinical history, biochemical analysis, and skeletal radiographs to facilitate early treatment and prevention complications, acknowledging its limited specificity.
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Affiliation(s)
- Rod Carlo Agram Columbres
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, CA, USA
- College of Osteopathic Medicine, William Carey University, Hattiesburg, MS, USA
| | - Sarosh Din
- College of Osteopathic Medicine, William Carey University, Hattiesburg, MS, USA
| | - Liliane Gibbs
- Department of Radiology, University of California, Irvine, CA, USA
| | - Virginia Kimonis
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, CA, USA.
- Department of Pathology, University of California, Irvine, CA, USA.
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10
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Vasikaran S, Thambiah SC, Tan RZ, Loh TP. The Use of Bone-Turnover Markers in Asia-Pacific Populations. Ann Lab Med 2024; 44:126-134. [PMID: 37869778 PMCID: PMC10628755 DOI: 10.3343/alm.2023.0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/03/2023] [Accepted: 09/14/2023] [Indexed: 10/24/2023] Open
Abstract
Bone-turnover marker (BTM) measurements in the blood or urine reflect the bone-remodeling rate and may be useful for studying and clinically managing metabolic bone diseases. Substantial evidence supporting the diagnostic use of BTMs has accumulated in recent years, together with the publication of several guidelines. Most clinical trials and observational and reference-interval studies have been performed in the Northern Hemisphere and have mainly involved Caucasian populations. This review focuses on the available data for populations from the Asia-Pacific region and offers guidance for using BTMs as diagnostic biomarkers in these populations. The procollagen I N-terminal propeptide and β-isomerized C-terminal telopeptide of type-I collagen (measured in plasma) are reference BTMs used for investigating osteoporosis in clinical settings. Premenopausal reference intervals (established for use with Asia-Pacific populations) and reference change values and treatment targets (used to monitor osteoporosis treatment) help guide the management of osteoporosis. Measuring BTMs that are not affected by renal failure, such as the bone-specific isoenzyme alkaline phosphatase and tartrate-resistant acid phosphatase 5b, may be advantageous for patients with advanced chronic kidney disease. Further studies of the use of BTMs in individuals with metabolic bone disease, coupled with the harmonization of commercial assays to provide equivalent results, will further enhance their clinical applications.
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Affiliation(s)
- Samuel Vasikaran
- Department of Clinical Biochemistry, Fiona Stanley Hospital, Perth, Australia
| | - Subashini C. Thambiah
- Department of Pathology, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Rui Zhen Tan
- Engineering Cluster, Singapore Institute of Technology, Singapore
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore
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Hasler J, Riede U, Helmy N, Graf A. Total elbow arthroplasty for elbow osteoarthritis associated with Paget's disease: A case report and review of literature. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:125-130. [PMID: 38323213 PMCID: PMC10840573 DOI: 10.1016/j.xrrt.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Affiliation(s)
- Julian Hasler
- Department for Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Ulf Riede
- Department for Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Naeder Helmy
- Department for Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Alexander Graf
- Department for Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
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12
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Hashimoto J, Arai Y, Kurosu S, Ikezaki T. Safety and effectiveness of risedronate in Paget's disease of bone: postmarketing surveillance study in Japan. J Bone Miner Metab 2024; 42:122-133. [PMID: 38197974 DOI: 10.1007/s00774-023-01486-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/05/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION We conducted an all-case postmarketing surveillance study between 2008 and 2017 to evaluate the safety and effectiveness of risedronate for Paget's disease of bone (PDB) in Japan. MATERIAL AND METHODS This study registered all patients who received once-daily risedronate 17.5 mg for the treatment of PDB and collected data over a 48-week follow-up period per treatment cycle for each patient. RESULTS The safety analysis set included 184 patients (mean age, 63.7 years), 81 (44.0%) of whom previously received a bisphosphonate. Of them, 41 (22.3%) experienced 72 adverse drug reactions (ADRs), and 8 (4.3%) experienced 14 serious ADRs. Common ADRs included gastrointestinal disorders (20 patients, 10.9%) and hypocalcemia (6 patients, 3.3%). The effectiveness analysis set included 182 patients, 124 of whom completed only one treatment cycle and 58 of whom completed multiple treatment cycles. The proportions of patients who normalized serum alkaline phosphatase (ALP) concentration were 71.1% (113/159 patients) and 67.3% (33/49 patients) for the first and second treatment cycles, respectively. The relapse rate according to ALP levels after the end of treatment for the first cycle was 5.0% (95% confidence interval [CI] = 2.1-11.5) at 24 weeks and 12.9% (95% CI = 7.5-21.7) at 40 weeks. Regarding pain relief, the achievement rates were 70.0% (49/70 patients) and 30.8% (4/13 patients) for the first and second treatment cycles, respectively. CONCLUSION To conclude, risedronate 17.5 mg/day is safe and effective for treating patients with PDB in daily practice.
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Affiliation(s)
- Jun Hashimoto
- National Hospital Organization Osaka Minami Medical Center, 2-1, Kido Higashimachi, Kawachinagano, Osaka, 586-8521, Japan
| | - Yuki Arai
- Medical Department, EA Pharma Co., Ltd., 2-1-1, Irifune, Chuo-ku, Tokyo, 104-0042, Japan.
| | - Shinsuke Kurosu
- Data Science Group, Clinical Development Department, EA Pharma Co., Ltd., 2-1-1, Irifune, Chuo-ku, Tokyo, 104-0042, Japan
| | - Toshimi Ikezaki
- Clinical Planning and Development Department, Medical Headquarters, Eisai Co., Ltd., 4-6-10, Koishikawa, Bunkyo-ku, Tokyo, 112-8088, Japan
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13
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Mukherjee S, Mahesh KV, Bhadada SK, Chatterjee D, Kumar R. The Role of Genetic Analysis in Demystifying the Diagnosis in a Middle-Aged Male Presenting With Proximal Muscle Weakness and Sclerotic-Lytic Skeletal Lesions. Cureus 2023; 15:e50924. [PMID: 38249245 PMCID: PMC10800001 DOI: 10.7759/cureus.50924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Paget's disease of bone (PDB) usually presents with bone pain and deformities. Herein, we describe a case of PDB who presented with gradually progressive quadriparesis. A man in his forties presented with gradually progressive proximal muscle weakness involving all four limbs. The patient had an elevated serum alkaline phosphatase level and osteosclerosis at various skeletal sites in a radiological skeletal survey. 18F-fluorodeoxyglucose (FDG) PET-CT showed FDG-avid sclerotic-lytic lesions at multiple skeletal sites. Histopathology evaluation of bone and muscle biopsy specimens revealed PDB and inclusion body myopathy (IBM) with neurogenic atrophy, respectively. A diagnosis of IBM associated with PDB without frontotemporal dementia (IBMPFD) was suspected and confirmed by exome sequencing, which revealed a heterozygous mutation in the VCP gene. The bone disease responded to zoledronate administration. A high index of suspicion for IBMPFD should be kept in mind in any patient with PDB presenting with proximal muscle weakness.
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Affiliation(s)
- Soham Mukherjee
- Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Karthik V Mahesh
- Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Sanjay K Bhadada
- Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Debajyoti Chatterjee
- Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Rajender Kumar
- Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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14
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Rizvi AH, Mobeen H, Ahmad A, Saghir H, Farhan A. Paget's Disease of Bone: A Rare Incidence in Early Adult Life in Pakistan, Southeast Asia. Cureus 2023; 15:e50242. [PMID: 38192941 PMCID: PMC10772316 DOI: 10.7759/cureus.50242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/10/2024] Open
Abstract
Paget's disease of bone (PDB) is a focal disorder of skeletal remodeling leading to alteration of bony structures and properties, uncommonly reported in people under the age of 40 years, particularly in the Southeast Asia region. In the literature, PDB has been well reported in regions of Europe, in contrast to Asia where there has been limited records of prevalence of PDM especially in the younger age population. Here, we report a 21-year-old male patient presenting with an advanced disease with complaints of auditory impairment, bone pain, and neurological signs due to compression of the interverbal disc developed progressively over two months, having an elevated serum alkaline phosphatase level of 601 IU/L. The patient was administered zoledronic acid that brought significant improvement in his health. We aim to signify the advanced presentation of PDB in our region to create awareness about the condition among physicians and aid in the prompt diagnosis and prevention of the most dreaded complications of the disease, such as osteosarcoma, secondary osteoarthritis, and fractures.
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Affiliation(s)
- Ali H Rizvi
- Internal Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PAK
| | - Hafsa Mobeen
- Internal Medicine, HBS Medical and Dental College, Islamabad, PAK
| | - Afaq Ahmad
- General Surgery, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PAK
| | - Hina Saghir
- Internal Medicine, HBS Medical and Dental College, Islamabad, PAK
| | - Ahmed Farhan
- Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PAK
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15
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Hajialiloo M, Tekantapeh ST. Paget's disease of bone in the patient presented with a bowed leg. Clin Case Rep 2023; 11:e8276. [PMID: 38046804 PMCID: PMC10689294 DOI: 10.1002/ccr3.8276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/12/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023] Open
Abstract
Key Clinical Message In dealing with bowed limbs along with increased alkaline phosphatase (ALP), even if the typical changes to the face are not very noticeable at first glance, Paget's disease of the bone (PDB) should be suspected, and the necessary investigations should be carried out to confirm the diagnosis. Abstract Paget's disease of the bone (PDB) is the second most prevalent metabolic bone disorder worldwide with disorganized bone remodeling. Here, a patient is presented with pain and bending of the right leg, whose skull and forehead changes are not noticeable at first glance, but with clinical suspicion and additional diagnostic evaluations, PDB diagnosis is confirmed for the patient.
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Affiliation(s)
- Mehrzad Hajialiloo
- Connective Tissue Diseases Research CenterTabriz University of Medical SciencesTabrizIran
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16
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Sharma S, Shankar R, Ravi Kiran BS, Breh R, Sarangi S, Kumar Upadhyay A. A Narrative Review of Osteonecrosis of the Jaw: What a Clinician Should Know. Cureus 2023; 15:e51183. [PMID: 38283469 PMCID: PMC10817767 DOI: 10.7759/cureus.51183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is an uncommon complication of antiresorptive therapy (ART) in patients receiving higher and more frequent doses of osteoclast inhibitors. The jaws are the most common site, as they have high bone turnover. The oral structures are exposed to various types of stresses, like mastication and dental diseases, which lead to microtrauma and increased bone remodeling. The hallmark feature of MRONJ is the area of exposed, necrotic, nonhealing, asymptomatic bone for more than eight weeks. Objective signs are pain in the jaw and oral cavity, loose teeth, gingival swelling, ulceration, soft tissue infection, and paresthesia in the trigeminal nerve branches' territory. Clinically, the MRONJ has been defined in four stages, from stage 0 to stage 3. Close coordination between the dentist and oncologist is critical for optimal treatment. Conservative management should be preferred over surgical management. There is significant underreporting and misdiagnosis of MRONJ cases in regular clinical practice. There needs to be more awareness among treating physicians about this sporadic complication of bisphosphonate therapy. This narrative review has given a detailed insight into the subject, starting with etiology, pathogenesis, incidence, clinical presentation, workup, staging, and various management strategies. The review article focuses mainly on practical aspects of MRONJ, which every clinician dealing with the disease must know. With a better awareness of this potential complication, healthcare practitioners dealing with at-risk patients can better diagnose, prevent, address, and provide necessary care.
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Affiliation(s)
- Swati Sharma
- Prosthodontics, Tata Main Hospital, Jamshedpur, IND
| | - Rama Shankar
- Oral and Maxillofacial Surgery, Tata Main Hospital, Jamshedpur, IND
| | | | - Rohit Breh
- Orthodontics, Tata Main Hospital, Jamshedpur, IND
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17
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Michou L, Gamache P, Guertin JR, Tarride JE, Brown JP, Jean S. Prevalence and incidence of Paget's disease of bone: Temporal trend over 20 years in the province of Quebec, Canada. Bone 2023; 176:116895. [PMID: 37683713 DOI: 10.1016/j.bone.2023.116895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Paget's disease of bone (PDB) is a focal bone disorder characterized by an increased bone remodeling and an anarchic bone structure. A decline of prevalence and incidence of PDB has been observed in some countries. No epidemiological data are available on PDB in Canada. AIMS We aimed at examining the evolution of the prevalence and incidence of PDB in Quebec (Canada) by analyzing health administrative databases. METHODS PDB case definition relied on one or more hospitalizations, or one or more physician-billing claims with a diagnosis code of PDB. To identify incident cases, a 'run-in' period of four years (1996-1999) was used to exclude prevalent cases. For each fiscal year from 2000 to 2001 to 2019-2020 (population size 2,914,480), crude age and sex-specific prevalence and incidence rates of PDB among individuals aged ≥55 years were determined, and sex-specific rates were also standardized to the 2011 age structure of the Quebec population. Generalized linear regressions were used to test for linear changes in standardized prevalence and incidence rates. RESULTS Over the study period, standardized prevalence of PDB has remained stable in Quebec, from 0.44 % in 2000/2001 to 0.43 % in 2019/2020 (mean change -0.002, p-value = 0.0935). For the 2019-2020 fiscal year, 13,165 men and women had been diagnosed with PDB and prevalence of PDB increased with age. Standardized incidence of PDB has decreased over time from 0.77/1000 in 2000/2001 to 0.28/1000 in 2019-2020 (mean change -0.228/year, p-value<0.0001), the incidence decreasing from 0.82/1000 to 0.37/1000 in men and from 0.76/1000 to 0.22/1000 in women, respectively. This decrease was observed in all age categories. CONCLUSION With the exception of a slight increase in PDB prevalence up to 0.55 % in years 2005 to 2007, the prevalence of PDB has remained stable in Quebec over the past 20 years, 13,160 men and women being currently diagnosed with PDB. The incidence has decreased over time. Our results support the epidemiological changes of PDB reported in other countries.
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Affiliation(s)
- Laetitia Michou
- CHU de Québec-Université Laval Research Centre, Quebec, Quebec, Canada; Department of Medicine, Université Laval, Quebec, Quebec, Canada.
| | - Philippe Gamache
- Institut national de santé publique du Québec, Quebec, Quebec, Canada
| | - Jason R Guertin
- CHU de Québec-Université Laval Research Centre, Quebec, Quebec, Canada; Department of preventive and social medicine, Université Laval, Quebec, Quebec, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jacques P Brown
- CHU de Québec-Université Laval Research Centre, Quebec, Quebec, Canada; Department of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Sonia Jean
- Institut national de santé publique du Québec, Quebec, Quebec, Canada; Department of preventive and social medicine, Université Laval, Quebec, Quebec, Canada
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18
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Nogueira D, Caldas IM, Dinis-Oliveira RJ. Bisphosphonates and osteonecrosis of the jaws: Clinical and forensic aspects. Arch Oral Biol 2023; 155:105792. [PMID: 37611492 DOI: 10.1016/j.archoralbio.2023.105792] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/30/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE This manuscript aims to provide a comprehensive review of the current knowledge in the pathophysiology, diagnosis, prevention, and other relevant clinical and forensic aspects of a potentially severe complication known as medication-related osteonecrosis of the jaw (MRONJ) while synthesizing state-of-the-art information on bisphosphonates and introducing a possible differential diagnosis. DESIGN An extensive search was conducted in PubMed (U.S. National Library of Medicine) without a time or language constraint, focusing on the epidemiology, pathophysiology, risk factors, site specificity, signs and symptoms, differential diagnosis, prevention, and forensic aspects of MRONJ. All types of original articles, reviews, case reports, short communications, opinion articles, guidelines, and letters to editors were considered to produce a complete review on this subject. RESULTS MRONJ prevention relies on a multidisciplinary approach and is critical since truly effective treatments are lacking. This therapeutic challenge is partly due to uncertainty regarding this condition's pathophysiology. Differential diagnosis of osteonecrosis of the jaws associated with krokodil abuse, one of the most dangerous and homemade psychoactive illicit substances, should be considered. CONCLUSIONS Further research into the etiology and site specificity of MRONJ is encouraged, aiming to develop novel treatment prospects. Indeed, comprehending this would allow for increased efficacy and therapeutic options while emphasizing the importance of prevention. In addition, we advocate for greater consensus among the various societies regarding MRONJ's treatment and management.
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Affiliation(s)
- Diana Nogueira
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; Faculty of Dental Medicine, University of Porto, Rua Dr. Manuel Pereira da Silva, 4200-393 Porto, Portugal.
| | - Inês Morais Caldas
- Faculty of Dental Medicine, University of Porto, Rua Dr. Manuel Pereira da Silva, 4200-393 Porto, Portugal; 1H-TOXRUN, One Health Toxicology Research Unit, University Institute of Health Sciences, CESPU, CRL, 4585-116 Gandra, Portugal; Centre for Functional Ecology (CFE), Department of Life Sciences, University of Coimbra, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal.
| | - Ricardo Jorge Dinis-Oliveira
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; 1H-TOXRUN, One Health Toxicology Research Unit, University Institute of Health Sciences, CESPU, CRL, 4585-116 Gandra, Portugal; UCIBIO/REQUIMTE, Laboratory of Toxicology, Faculty of Pharmacy, University of Porto, R. Jorge Viterbo Ferreira, No 228, 4050-313 Porto, Portugal.
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19
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Ling Z, Aini H, Kajikawa S, Shirakawa J, Tsuji K, Asou Y, Koga H, Sekiya I, Nifuji A, Noda M, Ezura Y. Osteolytic Bone Loss and Skeletal Deformities in a Mouse Model for Early-Onset Paget's Disease of Bone with PFN1 Mutation Are Treatable by Alendronate. Pharmaceuticals (Basel) 2023; 16:1395. [PMID: 37895866 PMCID: PMC10610320 DOI: 10.3390/ph16101395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
A novel osteolytic disorder due to PFN1 mutation was discovered recently as early-onset Paget's disease of bone (PDB). Bone loss and pain in adult PDB patients have been treated using bisphosphonates. However, therapeutic strategies for this specific disorder have not been established. Here, we evaluated the efficiency of alendronate (ALN) on a mutant mouse line, recapitulating this disorder. Five-week-old conditional osteoclast-specific Pfn1-deficient mice (Pfn1-cKOOCL) and control littermates (33 females and 22 males) were injected with ALN (0.1 mg/kg) or vehicle twice weekly until 8 weeks of age. After euthanizing, bone histomorphometric parameters and skeletal deformities were analyzed using 3D μCT images and histological sections. Three weeks of ALN administration significantly improved bone mass at the distal femur, L3 vertebra, and nose in Pfn1-cKOOCL mice. Histologically increased osteoclasts with expanded distribution in the distal femur were normalized in these mice. Geometric bone shape analysis revealed a partial recovery from the distal femur deformity. A therapeutic dose of ALN from 5 to 8 weeks of age significantly improved systemic bone loss in Pfn1-cKOOCL mice and femoral bone deformity. Our study suggests that preventive treatment of bony deformity in early-onset PDB is feasible.
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Affiliation(s)
- Zhu Ling
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University (TMDU), Tokyo 170-8455, Japan; (Z.L.)
| | - Hailati Aini
- Department of Nano-Bioscience, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Shuhei Kajikawa
- Department of Veterinary Medicine, Okayama University of Science, Imabari 794-8555, Japan
| | - Jumpei Shirakawa
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan
| | - Kunikazu Tsuji
- Department of Nano-Bioscience, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
- Department of Orthopedic Surgery, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Yoshinori Asou
- Department of Nano-Bioscience, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
- Department of Orthopedic Surgery, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University (TMDU), Tokyo 170-8455, Japan; (Z.L.)
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Akira Nifuji
- Department of Pharmacology, Tsurumi University School of Dental Medicine, Tsurumi, Yokohama 230-8501, Japan
| | - Masaki Noda
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Yoichi Ezura
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University (TMDU), Tokyo 170-8455, Japan; (Z.L.)
- Faculty of Occupational Therapy, Teikyo Heisei University, Tokyo 170-8445, Japan
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20
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Pishdad R, Moseley KF. Maladie osseuse de Paget. CMAJ 2023; 195:E1138. [PMID: 37640400 PMCID: PMC10462407 DOI: 10.1503/cmaj.230164-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Affiliation(s)
- Reza Pishdad
- Division de l'endocrinologie, du diabète et du métabolisme, Faculté de médecine de l'Université Johns Hopkins, Baltimore, Md.
| | - Kendall F Moseley
- Division de l'endocrinologie, du diabète et du métabolisme, Faculté de médecine de l'Université Johns Hopkins, Baltimore, Md
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Sathikumar AS, Jacob G, Varghese J, Mathew V. Total Knee Arthroplasty in Paget's Disease using 3D-Printed Patient-Specific Femoral Jig - A Case Report. J Orthop Case Rep 2023; 13:84-88. [PMID: 37654769 PMCID: PMC10465753 DOI: 10.13107/jocr.2023.v13.i08.3826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/17/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction Patients with Paget's disease develop abnormal bony anatomy which can result in significantly altered lower limb alignment predisposing them to early secondary osteoarthritis. Due to the severe extra-articular deformity, total knee arthroplasty (TKA) in these patients is challenging. Conventional knee arthroplasty using intramedullary guides is not an option and can lead to erroneous limb alignment postoperatively. Patient-specific instrumentation (PSI) is a simple solution in such complex primary knee arthroplasty. Case Report A 70-year-old male patient presented with a severe left femur deformity and left knee pain. He was diagnosed to have monostotic Paget's disease of the left femur with tricompartmental osteoarthritis of the left knee. After reduction in pathological bone turnover, the patient was planned for a total knee replacement. As a standard intramedullary femoral jig was not applicable due to the femoral deformity, a computed topography-based 3D-printed patient-specific instrument was used. This custom jig was used to define and perform the distal femur cut at 90 degrees to the mechanical axis of the femur in the coronal and sagittal plane. Postoperatively, the patient did well and achieved good function and pain relief. Conclusion The use of a 3D-printed PSI for complex primary knee arthroplasty is an excellent option with no additional operative time than a conventional knee arthroplasty. Although a robotic or computer-navigated TKA would be an excellent option in this case, we restored the limb alignment using a cost-effective patient-specific femoral jig. This could be a viable option in centers without navigation or robotic arthroplasty.
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Affiliation(s)
- Aravind Sai Sathikumar
- Department of Orthopaedics, Division of Joint Replacement and Sports Medicine, VPS Lakeshore Hospital, Lakeshore Hospital and Research Centre Ltd., Kochi, Kerala, India
| | - George Jacob
- Department of Orthopaedics, Division of Joint Replacement and Sports Medicine, VPS Lakeshore Hospital, Lakeshore Hospital and Research Centre Ltd., Kochi, Kerala, India
| | - Jacob Varghese
- Department of Orthopaedics, Division of Joint Replacement and Sports Medicine, VPS Lakeshore Hospital, Lakeshore Hospital and Research Centre Ltd., Kochi, Kerala, India
| | - Vivek Mathew
- Department of Endocrinology, VPS Lakeshore Hospital, Lakeshore Hospital and Research Centre Ltd., Kochi, Kerala, India
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Üstün F, Ustabaşıoğlu F, Tokuç B, Bülbül BY, Çelik M, Aytürk S. PAGET'S DISEASE OF THE BONE FOUND INCIDENTALLY ON F-18 FDG PET/CT: CLINICAL SIGNIFICANCE AND DIFFERENTIAL DIAGNOSTIC CRITERIA. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2023; 19:292-300. [PMID: 38356987 PMCID: PMC10863963 DOI: 10.4183/aeb.2023.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Background Paget Disease (PD) is usually asymptomatic and discovered incidentally, it is known that it is exhibited low to high grade increased F-18 FDG uptake. Aim In this study, we investigated the distinguishability of FDG PET/CT in incidental PD cases from other bone diseases and at different stages of the disease. Patients and Methods In this cross-sectional, descriptive study, "Paget" identification associated with PET/CT reports was found in 69 of 18,119 studies (~3.8%). Of the 45 patients (33 males and 12 females) eligible for inclusion in the study, 35.6% had monostotic and 64.4% had polyostotic disease (p>0.5). There was no statistically significant difference in biochemical parameters between groups. Results According to the radiological appearance of the patients, 36 were in the mixed stage and 9 were in the blastic stage. Only the difference in ALP and creatinine values between the groups was statistically significant. SUVmax, SUVmean and HU values were found to be statistically significantly higher in pagetoid bones compared to control bone lesions. For SUVmax for PD bone lesion we found the 2.55 cutoff point with a sensitivity of 91% and a specificity of 84%. Conclusion The specific radiological appearance of bone lesions and the evaluation of metabolic activity compared to normal bone seem to help differentiate PD from other lesions. Prospective studies are needed in the differentiation of FDG's disease stage and treatment response evaluation. The ability to differentiate between benign and malignant FDG avid bone lesions in oncological patients' enables appropriate patient management, including avoiding unnecessary additional invasive procedures such as bone biopsy.
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Affiliation(s)
- F. Üstün
- Trakya University, Faculty of Medicine, Department of Nuclear Medicine, Edirne
| | - F.E. Ustabaşıoğlu
- Trakya University, Faculty of Medicine, Department of Radiology, Edirne
| | - B. Tokuç
- Namık Kemal University, Faculty of Medicine, Department of Public Health, Tekirdağ
| | - B. Yımaz Bülbül
- Namık Kemal University, Faculty of Medicine, Department of Public Health, Tekirdağ
| | - M. Çelik
- Trakya University, Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Edirne
| | - S. Aytürk
- Kayseri City Hospital, Department of Endocrinology and Metabolic Diseases, Kayseri, Turkey
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23
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Battal B, Zamora C. Imaging of Skull Base Tumors. Tomography 2023; 9:1196-1235. [PMID: 37489465 PMCID: PMC10366931 DOI: 10.3390/tomography9040097] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/26/2023] Open
Abstract
The skull base provides a platform for supporting the brain while serving as a conduit for major neurovascular structures. In addition to malignant lesions originating in the skull base, there are many benign entities and developmental variants that may simulate disease. Therefore, a basic understanding of the relevant embryology is essential. Lesions centered in the skull base can extend to the adjacent intracranial and extracranial compartments; conversely, the skull base can be secondarily involved by primary extracranial and intracranial disease. CT and MRI are the mainstay imaging methods and are complementary in the evaluation of skull base lesions. Advances in cross-sectional imaging have been crucial in the management of patients with skull base pathology, as this represents a complex anatomical area that is hidden from direct clinical exam. Furthermore, the clinician must rely on imaging studies for therapy planning and to monitor treatment response. It is crucial to have a thorough understanding of skull base anatomy and its various pathologies, as well as to recognize the appearance of treatment-related changes. In this review, we aim to describe skull base tumors and tumor-like lesions in an anatomical compartmental approach and present imaging methods that aid in diagnosis, management, and follow-up.
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Affiliation(s)
- Bilal Battal
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Carlos Zamora
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
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Gendron E, Bouchard F, Singbo N, Brown JP, Michou L. Decline in clinical severity of Paget's disease of bone: Comparison between a contemporary cohort and a historical cohort. Bone 2023; 170:116721. [PMID: 36858336 DOI: 10.1016/j.bone.2023.116721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND European and Australian studies have reported a decrease in the prevalence, incidence and clinical severity of Paget's disease of bone (PDB). There are no studies on the current clinical characteristics of PDB in Quebec, Canada. AIMS The purpose of this study was to describe the characteristics of unrelated patients with PDB diagnosed after the year 2000 in our region and to compare them to a historical cohort diagnosed before 2000. METHODS In this retrospective descriptive cohort study, socio-demographic data and clinical characteristics for the contemporary cohort were collected from electronic medical records of patients with PDB followed at our university hospital. For the historical cohort, the same data were collected from the research files of PDB participants in our research program. Inclusion criteria were: age > 18 years, having PDB diagnosed by a rheumatologist, and being followed in our hospital. Exclusion criteria were: having a relative with PDB participating in this study. Variables were reported as mean, standard deviation, frequency and percentage. Chi-square tests were used to compare categorical variables. Continuous values were compared with Wilcoxon-Mann-Whitney tests. Unadjusted p-values and adjusted p-values with the Bonferroni correction method were calculated. A p-value <0.05 was considered statistically significant. RESULTS Among the 195 patients with PDB in the contemporary cohort, 53.3 % were men, 60.5 % had monostotic involvement, 14.2 % were symptomatic at diagnosis. In comparison to the historical cohort of 173 patients, patients in the contemporary cohort were older at diagnosis (68.7 10.7 vs. 58.5 10.1; p < 0.0001) and had less family history of PDB (13.8 % vs. 33.6 %; p = 0.0024). They also had lower total alkaline phosphatase levels at diagnosis (118.0 (85.0-184.0)) vs. 184.0 (115.0-312.0)); p = 0.0006), a lower pagetic bone number (1.0 (1.0-3.0) vs. 2.0 (1.0-5.0); p < 0.0001), lower pagetic bone fractures (6.7 % vs. 36.7 %; p = 0.0078) and lower bone deformities (13.0 % vs. 54.0 %; p < 0.0001). There was no significant difference for pagetic bone pain (52.0 % vs. 52.6 %; p = 1.0000), percentage of patients who had orthopedic surgery related to PDB complications (8.8 % vs. 28.6 %; p = 1.0000), secondary osteoarthritis (43.0 % vs. 51.6 %; p = 1.0000), and hearing impairment (51.9 % vs. 61.1 %; p = 0.1000). CONCLUSION The contemporary cohort is characterized by an older age at diagnosis, a majority of monostotic disease and fewer complications of PDB. This decline in clinical severity of PDB in Quebec is consistent with studies reported in other countries.
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Affiliation(s)
- Evelyne Gendron
- Division of Rheumatology, Department of Medicine, CHU de Québec - Université Laval, 2705 boulevard Laurier, Québec, Québec G1V 4G2, Canada
| | - Frédérik Bouchard
- Department of Medicine, Faculty de Medicine, Université Laval, Québec, Québec, Canada
| | - Narcisse Singbo
- Research Centre of CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Jacques P Brown
- Research Centre of CHU de Québec-Université Laval, Québec, Québec, Canada; Department of Medicine, Faculty de Medicine, Université Laval, Québec, Québec, Canada
| | - Laëtitia Michou
- Division of Rheumatology, Department of Medicine, CHU de Québec - Université Laval, 2705 boulevard Laurier, Québec, Québec G1V 4G2, Canada; Research Centre of CHU de Québec-Université Laval, Québec, Québec, Canada; Department of Medicine, Faculty de Medicine, Université Laval, Québec, Québec, Canada.
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Banaganapalli B, Fallatah I, Alsubhi F, Shetty PJ, Awan Z, Elango R, Shaik NA. Paget's disease: a review of the epidemiology, etiology, genetics, and treatment. Front Genet 2023; 14:1131182. [PMID: 37180975 PMCID: PMC10169728 DOI: 10.3389/fgene.2023.1131182] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 04/17/2023] [Indexed: 05/16/2023] Open
Abstract
Paget's disease of bone (PDB) is the second most prevalent metabolic bone disorder worldwide, with a prevalence rate of 1.5%-8.3%. It is characterized by localized areas of accelerated, disorganized, and excessive bone production and turnover. Typically, PDB develops in the later stages of life, particularly in the late 50s, and affects men more frequently than women. PDB is a complex disease influenced by both genetic and environmental factors. PDB has a complex genetic basis involving multiple genes, with SQSTM1 being the gene most frequently associated with its development. Mutations affecting the UBA domain of SQSTM1 have been detected in both familial and sporadic PDB cases, and these mutations are often associated with severe clinical expression. Germline mutations in other genes such as TNFRSF11A, ZNF687 and PFN1, have also been associated with the development of the disease. Genetic association studies have also uncovered several PDB predisposing risk genes contributing to the disease pathology and severity. Epigenetic modifications of genes involved in bone remodelling and regulation, including RANKL, OPG, HDAC2, DNMT1, and SQSTM1, have been implicated in the development and progression of Paget's disease of bone, providing insight into the molecular basis of the disease and potential targets for therapeutic intervention. Although PDB has a tendency to cluster within families, the variable severity of the disease across family members, coupled with decreasing incidence rates, indicates that environmental factors may also play a role in the pathophysiology of PDB. The precise nature of these environmental triggers and how they interact with genetic determinants remain poorly understood. Fortunately, majority of PDB patients can achieve long-term remission with an intravenous infusion of aminobisphosphonates, such as zoledronic acid. In this review, we discuss aspects like clinical characteristics, genetic foundation, and latest updates in PDB research.
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Affiliation(s)
- Babajan Banaganapalli
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ibrahim Fallatah
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fai Alsubhi
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Preetha Jayasheela Shetty
- Department of Biomedical Sciences, College of Medicine, Gulf Medical University, Ajman, United Arab Emirates
| | - Zuhier Awan
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ramu Elango
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Noor Ahmad Shaik
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia
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Merlotti D, Rendina D, Cavati G, Abate V, Falchetti A, Mingiano C, Nuti R, Gennari L. Drug treatment strategies for Paget's disease: relieving pain and preventing progression. Expert Opin Pharmacother 2023; 24:715-727. [PMID: 36961938 DOI: 10.1080/14656566.2023.2196011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
INTRODUCTION Paget's disease of bone (PDB) is a focal bone disorder caused by a marked dysregulation of osteoblasts and osteoclasts in basic multicellular units, leading to abnormal and disorganized deposition of collagen fibers (the so-called "woven bone"). Therefore, pagetic bones are increased in size, and at increased risk for bone pain, deformities, fractures, osteoarthritis, and, more rarely, neoplastic degeneration. AREAS COVERED In this review we revise the available information concerning the pharmacological treatment of PDB. EXPERT OPINION PDB progresses slowly within the affected skeletal sites and, if untreated, often leads to bone overgrowth, with bone pain, deformity and a likely increased risk of complications. Thus, the primary goal of treatment is the restoration of a normal bone turnover, in order to relieve bone pain or other symptoms and possibly prevent the complications. PDB long remained a poorly treatable disorder until the discovery of antiresorptive agents such as calcitonin first and bisphosphonates (BPs) later. With the recent development of potent intravenous BPs like zoledronate, allowing a better control of disease activity over the long term with a single infusion, has contributed to a marked improvement of the clinical management of this invalidating disorder.
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Affiliation(s)
- Daniela Merlotti
- Department of Medical Sciences, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Domenico Rendina
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Guido Cavati
- Department of Medicine Surgery and Neurosciences University of Siena ITALY
| | - Veronica Abate
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Alberto Falchetti
- Experimental Research Laboratory on Bone Metabolism, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Auxologico Italiano, Milan, Italy
| | - Christian Mingiano
- Department of Medicine Surgery and Neurosciences University of Siena ITALY
| | - Ranuccio Nuti
- Department of Medicine Surgery and Neurosciences University of Siena ITALY
| | - Luigi Gennari
- Department of Medicine Surgery and Neurosciences University of Siena ITALY
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Schini M, Vilaca T, Gossiel F, Salam S, Eastell R. Bone Turnover Markers: Basic Biology to Clinical Applications. Endocr Rev 2022; 44:417-473. [PMID: 36510335 PMCID: PMC10166271 DOI: 10.1210/endrev/bnac031] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 11/26/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022]
Abstract
Bone turnover markers (BTMs) are used widely, in both research and clinical practice. In the last 20 years, much experience has been gained in measurement and interpretation of these markers, which include commonly used bone formation markers bone alkaline phosphatase, osteocalcin, and procollagen I N-propeptide; and commonly used resorption markers serum C-telopeptides of type I collagen, urinary N-telopeptides of type I collagen and tartrate resistant acid phosphatase type 5b. BTMs are usually measured by enzyme-linked immunosorbent assay or automated immunoassay. Sources contributing to BTM variability include uncontrollable components (e.g., age, gender, ethnicity) and controllable components, particularly relating to collection conditions (e.g., fasting/feeding state, and timing relative to circadian rhythms, menstrual cycling, and exercise). Pregnancy, season, drugs, and recent fracture(s) can also affect BTMs. BTMs correlate with other methods of assessing bone turnover, such as bone biopsies and radiotracer kinetics; and can usefully contribute to diagnosis and management of several diseases such as osteoporosis, osteomalacia, Paget's disease, fibrous dysplasia, hypophosphatasia, primary hyperparathyroidism, and chronic kidney disease-mineral bone disorder.
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Affiliation(s)
- Marian Schini
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Tatiane Vilaca
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Fatma Gossiel
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Syazrah Salam
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Richard Eastell
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Zhao J, Liang G, Luo M, Yang W, Xu N, Luo M, Pan J, Liu J, Zeng L. Influence of type 2 diabetes microangiopathy on bone mineral density and bone metabolism: A meta-analysis. Heliyon 2022; 8:e11001. [PMID: 36267364 PMCID: PMC9576898 DOI: 10.1016/j.heliyon.2022.e11001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/19/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
Abstract
Background Diabetic microangiopathy is a type of vascular dysfunction. The effect of type 2 diabetes microangiopathy (DMA) on bone mineral density (BMD) and bone metabolism is still unclear. Objective A meta-analysis was performed to investigate the effects of microangiopathy on BMD and bone metabolism in type 2 diabetic patients. Methods We searched the PubMed, Embase, Cochrane Library and CNKI databases to identify observational studies investigating the effects of type 2 diabetes microangiopathy on BMD or bone metabolism. The time limit for the literature retrieval was from the establishment of the database to September 25, 2021. The Newcastle–Ottawa scale (NOS) and the Agency for Healthcare Research and Quality (AHRQ) scale were used to evaluate the quality of the studies. RevMan 5.3 software was used for the data analysis. Stata 14.0 was used to quantitatively evaluate the publication bias of the outcome indicators. Results In total, 12 observational studies were included, including 7 cohort studies, 4 case–control studies and 1 cross-sectional study. In total, 2,500 patients with type 2 diabetes were included. Among them, 1,249 patients had microangiopathy (DMA group), and 1,251 patients did not have microangiopathy (control group). The results of the meta-analysis showed that the BMDs of the femoral neck (SMD = −1.34, 95% CI = −2.22 to −0.45, P = 0.003), lumbar spine (SMD = −0.69, 95% CI = −1.31 to −0.08, P = 0.03) and Ward's triangle (SMD = −2.84, 95% CI = −4.84 to −0.83, P = 0.006) in the DMA group were lower than those in the control group. In the comparison of the bone metabolism indexes, the contents of N-terminal propeptide of type I procollagen (P1NP) (SMD = 0.18, 95% CI = 0.03 to 0.32, P = 0.02), osteocalcin (SMD = 6.97, 95% CI = 3.46 to 10.48, P < 0. 0001), parathyroid hormone (PTH) (SMD = 0.38, 95% CI = 0.03 to 0.73, P = 0.03) and C-telopeptide of type 1 collagen (CTX) (SMD = 0.39, 95% CI = 0.03 to 0.75, P = 0.03) in serum from the DMA group were higher than those in serum from the control group. The serum content of 25-hydroxyvitamin D3 (25(OH)D3) (SMD = −0.63, 95% CI = −1.19 to −0.07, P = 0.03) in the DMA group was lower than that in the control group. There was no significant difference in serum alkaline phosphatase (ALP), calcium or phosphorus between the two groups (P > 0.05). Conclusions Type 2 diabetes microangiopathy can reduce the lumbar spine, femoral neck and Ward's triangle BMD and has a higher risk of osteoporosis or osteoporosis fractures. The levels of P1NP, PTH, CTX and OC in the serum of patients with type 2 diabetes microangiopathy are higher, and the lower 25(OH)D3 content may be a mechanism by which DMA destroys bone metabolism balance. The effect of type 2 diabetes microangiopathy on bone mineral density and bone metabolism is still unclear. Type 2 diabetes microangiopathy can reduce the lumbar spine, femoral neck and Ward's triangle BMD. Type 2 diabetes microangiopathy has a higher risk of osteoporosis or osteoporosis fractures.
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Affiliation(s)
- Jinlong Zhao
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, China
| | - Guihong Liang
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, China
| | - Miaohui Luo
- The Graduate School of Guangzhou University of Chinese Medicine, Guangzhou 510006, China
| | - Weiyi Yang
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, China
| | - Nanjun Xu
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Minghui Luo
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, China
| | - Jianke Pan
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, China
| | - Jun Liu
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, China
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
- Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou 510095, China
- Corresponding author.
| | - Lingfeng Zeng
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, China
- Corresponding author.
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Lombardi AF, Aihara AY, Fernandes ADRC, Cardoso FN. Imaging of Paget's Disease of Bone. Radiol Clin North Am 2022; 60:561-573. [PMID: 35672089 DOI: 10.1016/j.rcl.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Paget's disease is a metabolic bone disorder affecting the elderly and characterized by bone resorption followed by compensatory bone formation. Radiography is the imaging modality of choice for the diagnosis whereas bone scintigraphy helps stage the extent of the disease and assess response to treatment. MRI and CT are important imaging methods in the assessment of complications and surgical planning. Osteolytic lesions of Paget's first phase present with well-defined margins on radiographs, most commonly in the femur, pelvis, and skull. Cortical thickening, trabecular coarsening, bone marrow sclerosis, and deformities of long bones are present in the mixed- and late-sclerotic phases.
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Affiliation(s)
- Alecio F Lombardi
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA; Department of Radiology, University of California San Diego, San Diego, CA 92037, USA.
| | - André Yui Aihara
- Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, SP 04024-000, Brazil; Diagnósticos da América (DASA), São Paulo, SP 05425-020, Brazil
| | | | - Fabiano Nassar Cardoso
- Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL 33136, USA
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Tsiantouli E, Biver E, Chevalley T, Petrovic R, Hannouche D, Ferrari S. Prevalence of Low Serum Alkaline Phosphatase and Hypophosphatasia in Adult Patients with Atypical Femur Fractures. Calcif Tissue Int 2022; 110:703-711. [PMID: 35229197 PMCID: PMC9108106 DOI: 10.1007/s00223-022-00949-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/17/2022] [Indexed: 12/13/2022]
Abstract
Hypophosphatasia (HPP) is a rare genetic disorder characterized by low serum alkaline phosphatase (ALP), its manifestations may include atypical femoral fractures (AFF). However, the prevalence of low serum ALP and HPP in patients with AFF remains unknown. We retrospectively analyzed ALP levels and clinical manifestations compatible with HPP in 72 adult patients with confirmed AFF by chart review. ALP values were compared with those of a control group of patients with prior proximal femoral fracture during antiresorptive treatment (n = 20). Among the AFF patients, 18 (25%) had at least one serum ALP value ≤ 40 IU/L, although in all but one case, at least one ALP value > 40 IU/L was also detected at another time point. Most low ALP values were associated with antiresorptive treatment (P = 0.049) and lowest levels of ALP did not differ between the AFF and the control groups (P = 0.129). However, low ALP values among AFF patients were associated with a higher rate of bilateral AFF (50% vs 22%, P = 0.025), metatarsal fracture (33% vs 7%, P = 0.006), and with trends for more frequent use of glucocorticoid (22% vs 8%, P = 0.089) and proton pump inhibitor (61% vs 44%, P = 0.220). In one AFF patient with low ALP and clinical suspicion of HPP, a rare pathogenic heterozygous variant of the ALPL gene was identified. In conclusion, low ALP values are common among subjects with AFF and mainly related to concomitant antiresorptive medication. Hence, low serum ALP has low specificity for HPP among AFF patients.
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Affiliation(s)
- Eleni Tsiantouli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Emmanuel Biver
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Thierry Chevalley
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Robert Petrovic
- Institute of Medical Biology, Genetics and Clinical Genetics, University Hospital Bratislava, Bratislava, Slovakia
| | - Didier Hannouche
- Division of Orthopedic Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Serge Ferrari
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Service and Laboratory of Bone Diseases, Department of Medicine, Geneva University Hospitals (HUG), 64 avenue de la Roseraie, 1205, Geneva, Switzerland.
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Luo Q, Gao Z, Xiao Q, Song E. One-Step Determination of Alkaline Phosphatase in Human Serum Based on Manganese (IV) Dioxide/Manganese (II)-Mediated Nuclear Magnetic Resonance (NMR) Relaxation. ANAL LETT 2022. [DOI: 10.1080/00032719.2022.2076108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Qin Luo
- Key Laboratory of Luminescence and Real-Time Analytical Chemistry, Ministry of Education, College of Pharmaceutical Sciences, Southwest University, Chongqing, China
| | - Zhenping Gao
- Key Laboratory of Luminescence and Real-Time Analytical Chemistry, Ministry of Education, College of Pharmaceutical Sciences, Southwest University, Chongqing, China
| | - Qinni Xiao
- Key Laboratory of Luminescence and Real-Time Analytical Chemistry, Ministry of Education, College of Pharmaceutical Sciences, Southwest University, Chongqing, China
| | - Erqun Song
- Key Laboratory of Luminescence and Real-Time Analytical Chemistry, Ministry of Education, College of Pharmaceutical Sciences, Southwest University, Chongqing, China
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Sclerostin: From Molecule to Clinical Biomarker. Int J Mol Sci 2022; 23:ijms23094751. [PMID: 35563144 PMCID: PMC9104784 DOI: 10.3390/ijms23094751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/12/2022] [Accepted: 04/22/2022] [Indexed: 12/23/2022] Open
Abstract
Sclerostin, a glycoprotein encoded by the SOST gene, is mainly produced by mature osteocytes and is a critical regulator of bone formation through its inhibitory effect on Wnt signaling. Osteocytes are differentiated osteoblasts that form a vast and highly complex communication network and orchestrate osteogenesis in response to both mechanical and hormonal cues. The three most commonly described pathways of SOST gene regulation are mechanotransduction, Wnt/β-catenin, and steroid signaling. Downregulation of SOST and thereby upregulation of local Wnt signaling is required for the osteogenic response to mechanical loading. This review covers recent findings concerning the identification of SOST, in vitro regulation of SOST gene expression, structural and functional properties of sclerostin, pathophysiology, biological variability, and recent assay developments for measuring circulating sclerostin. The three-dimensional structure of human sclerostin was generated with the AlphaFold Protein Structure Database applying a novel deep learning algorithm based on the amino acid sequence. The functional properties of the 3-loop conformation within the tertiary structure of sclerostin and molecular interaction with low-density lipoprotein receptor-related protein 6 (LRP6) are also reviewed. Second-generation immunoassays for intact/biointact sclerostin have recently been developed, which might overcome some of the reported methodological obstacles. Sclerostin assay standardization would be a long-term objective to overcome some of the problems with assay discrepancies. Besides the use of age- and sex-specific reference intervals for sclerostin, it is also pivotal to use assay-specific reference intervals since available immunoassays vary widely in their methodological characteristics.
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Affiliation(s)
- Yoshiyuki Nakatsuji
- Department of Gastroenterology and Internal Medicine, Marunouchi Hospital, Japan
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Wani S, Daroszewska A, Salter DM, van ‘t Hof RJ, Ralston SH, Albagha OME. The Paget's disease of bone risk gene PML is a negative regulator of osteoclast differentiation and bone resorption. Dis Model Mech 2022; 15:dmm049318. [PMID: 35229101 PMCID: PMC9066519 DOI: 10.1242/dmm.049318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/21/2022] [Indexed: 01/08/2023] Open
Abstract
Paget's disease of bone (PDB) is characterized by focal increases in bone remodelling. Genome-wide association studies identified a susceptibility locus for PDB tagged by rs5742915, which is located within the PML gene. Here, we have assessed the candidacy of PML as the predisposing gene for PDB at this locus. We found that the PDB-risk allele of rs5742915 was associated with lower PML expression and that PML expression in blood cells from individuals with PDB was lower than in controls. The differentiation, survival and resorptive activity of osteoclasts prepared from Pml-/- mice was increased compared with wild type. Furthermore, the inhibitory effect of IFN-γ on osteoclast formation from Pml-/- was significantly blunted compared with wild type. Bone nodule formation was also increased in osteoblasts from Pml-/- mice when compared with wild type. Although microCT analysis of trabecular bone showed no differences between Pml-/- mice and wild type, bone histomorphometry showed that Pml-/- mice had high bone turnover with increased indices of bone resorption and increased mineral apposition rate. These data indicate that reduced expression of PML predisposes an individual to PDB and identify PML as a novel regulator of bone metabolism. This article has an associated First Person interview with the first author of the paper.
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Affiliation(s)
- Sachin Wani
- Rheumatology and Bone Disease Unit, Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Anna Daroszewska
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Donald M. Salter
- Rheumatology and Bone Disease Unit, Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Rob J. van ‘t Hof
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
- Vanthof Scientific, Torun 87-100, Poland
| | - Stuart H. Ralston
- Rheumatology and Bone Disease Unit, Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Omar M. E. Albagha
- Rheumatology and Bone Disease Unit, Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, P.O. Box 34110, Qatar
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Poznański P, Lepiesza A, Jędrzejuk D, Mazanowska O, Bolanowski M, Krajewska M, Kamińska D. Is a Patient with Paget's Disease of Bone Suitable for Living Kidney Donation?-Decision-Making in Lack of Clinical Evidence. J Clin Med 2022; 11:jcm11061485. [PMID: 35329811 PMCID: PMC8951425 DOI: 10.3390/jcm11061485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/24/2022] [Accepted: 03/08/2022] [Indexed: 12/25/2022] Open
Abstract
Living donor kidney transplantation is a widely performed medical procedure. Living kidney donation requires an in-depth health assessment of candidates. The potential living kidney donor must remain healthy after kidney removal. A consequence of donation can be a decrease in glomerular filtration rate (GFR), and donors can become at risk of developing chronic kidney disease (CKD). We present a rationale for potential living kidney donor withdrawal due to Paget's disease of bone (PDB) based on a literature review. The treatment for PDB includes the use of, for example, non-steroidal anti-inflammatory drugs (NSAIDs), which can lead to acute kidney injury (AKI) as well as CKD, or bisphosphonates, which are not recommended for patients with decreased GFR.
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Affiliation(s)
- Paweł Poznański
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.P.); (O.M.); (M.K.); (D.K.)
| | - Agnieszka Lepiesza
- Department of Vascular, General and Transplantation Surgery, Jan Mikulicz-Radecki University Clinical Hospital, Borowska 213, 50-556 Wroclaw, Poland;
| | - Diana Jędrzejuk
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeze L. Pasteura 4, 50-367 Wroclaw, Poland;
- Correspondence:
| | - Oktawia Mazanowska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.P.); (O.M.); (M.K.); (D.K.)
| | - Marek Bolanowski
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeze L. Pasteura 4, 50-367 Wroclaw, Poland;
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.P.); (O.M.); (M.K.); (D.K.)
| | - Dorota Kamińska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.P.); (O.M.); (M.K.); (D.K.)
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Oprea V, Bojincă V, Bălănescu AR, Tatu A, Bojincă M, Romila A. Paget's disease of bone and megaloblastic anemia in a 72‑year‑old patient: A case report and systematic literature review. Exp Ther Med 2022; 23:269. [PMID: 35251335 PMCID: PMC8892619 DOI: 10.3892/etm.2022.11195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/30/2021] [Indexed: 11/21/2022] Open
Abstract
Paget's disease of bone (PDB) is characterized by abnormal osteoclastic bone resorption with disorganized bone neo-formation, primarily affecting elderly (>55 years) patients. Although the majority of patients are asymptomatic, some patients may experience bone pain due to local periosteal involvement or osteoarthritic lesions in the spine; in addition, limb deformities may lead to secondary gait problems or degenerative joint changes. Anemia has an overall prevalence of 12-17% in elderly adults (>65 years old), with macrocytic anemia being the less common type. Megaloblastic anemia is a macrocytic anemia characterized by the presence of large, immature, nucleated cells (megaloblasts) in the blood, with the most common cause being a deficiency of folate and/or vitamin B12. We herein report the rare case of a 72-year-old male patient exhibiting both these conditions, with the aim of discussing the possible association between the two and, most importantly, the clinical management of the patient in a real-life setting over a period of 10 years. The patient was diagnosed based on clinical symptoms (bone pain), radiological imaging and specific laboratory tests, and received discontinuous courses of bisphosphonates and cyanocobalamin supplementation therapy, based mainly on aggravated symptomatology. A systematic literature review was also performed and revealed not only the scarcity of reports on similar cases, but also the mechanisms that may underlie the possible association of PDB with macrocytic anemia due to vitamin B12 deficiency in elderly patients.
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Affiliation(s)
- Violeta Oprea
- Department of Geriatrics and Gerontology, ‘St. Apostle Andrei’ Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Violeta Bojincă
- Department of Internal Medicine and Rheumatology, ‘Sf. Maria’ Clinical Hospital, 011172 Bucharest, Romania
| | - Andra-Rodica Bălănescu
- Department of Internal Medicine and Rheumatology, ‘Sf. Maria’ Clinical Hospital, 011172 Bucharest, Romania
| | - Alin Tatu
- Clinical‑Medical Department, Dermatology, Faculty of Medicine and Pharmacy, ‘Dunărea de Jos’ University of Galati, ReForm UDJ, 800216 Galați, Romania
| | - Mihai Bojincă
- Department of Internal Medicine, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Aurelia Romila
- Department of Geriatrics and Gerontology, ‘St. Apostle Andrei’ Clinical Emergency County Hospital, 800578 Galați, Romania
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Effects on bone regeneration of single-dose treatment with osteogenic small molecules. Drug Discov Today 2022; 27:1538-1544. [DOI: 10.1016/j.drudis.2022.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/08/2022] [Accepted: 02/22/2022] [Indexed: 12/23/2022]
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Abstract
PURPOSE OF REVIEW This review provides suggestions for the evaluation of patients with osteoporosis in order to assure that the diagnosis is correct, to identify potentially correctable conditions contributing to skeletal fragility and fracture risk, and to assist in individualizing management decisions. RECENT FINDINGS Some patients who appear to have osteoporosis have another skeletal disease, such as osteomalacia, that requires further evaluation and treatment that is different than for osteoporosis. Many patients with osteoporosis have contributing factors (e.g., vitamin D deficiency, high fall risk) that should be addressed before and after starting treatment to assure that treatment is effective and safe. Evaluation includes a focused medical history, skeletal-related physical examination, assessment of falls risk, appropriate laboratory tests, and rarely transiliac double-tetracycline labeled bone biopsy. Evaluation of patients with osteoporosis before starting treatment is essential for optimizing clinical outcomes.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, 300 Oak St. NE, Albuquerque, NM, 87106, USA.
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Tao X, Liu L, Yang X, Wei Z, Chen Z, Zhang G, Zhang Z, Yue H. Clinical Characteristics and Pathogenic Gene Identification in Chinese Patients With Paget's Disease of Bone. Front Endocrinol (Lausanne) 2022; 13:850462. [PMID: 35355568 PMCID: PMC8959906 DOI: 10.3389/fendo.2022.850462] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/07/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the clinical features of sporadic Paget's disease of bone (PDB) in China and further explore the underlying genetic abnormalities of the disease. METHODS Clinical characteristics, biochemical indices, bone turnover markers and radiographic examinations of the patients were collected. Genomic DNA was extracted from peripheral blood and whole-exome sequencing was carried out to identify the potential pathogenic genes. The pathogenicity of the variants was thereafter investigated by bioinformatics analysis. RESULTS A total of 50 patients (57.20 ± 15.52 years, male/female: 1.63: 1) with PDB were included and the mean onset age was 48.34 years (48.34 ± 17.24 years). 94.0% of the patients exhibited symptomatic patterns described as bone pain (86.0%), elevated skin temperature at the lesion site (26.0%), bone deformity (22.0%) and local swelling (18.0%). The most frequently involved lesion sites were pelvis (52.0%), femur (42.0%), tibia (28.0%), skull (28.0%) and spine (18.0%), respectively. Additionally, 40.0% of them accompanied with osteoarthritis, 14.0% with pathological fractures, and the misdiagnosis rate of PDB was as high as 36.0%. Serum level of alkaline phosphatase was significantly increased, with the mean value of 284.00 U/L (quartiles, 177.00-595.00 U/L). Two heterozygous missense mutations of SQSTM1 gene (c.1211T>C, M404T) and one novel heterozygous missense mutation in HNRNPA2B1 gene (c.989C>T, p. P330L) were identified in our study. Moreover, several potential disease-causing genes were detected and markedly enriched in the pathways of neurodegeneration (including WNT16, RYR3 and RYR1 genes) and amyotrophic lateral sclerosis (ALS, including NUP205, CAPN2, and NUP214 genes). CONCLUSION In contrast to Western patients, Chinese patients have an earlier onset age, more severe symptoms, and lower frequency of SQSTM1 gene mutation (4.0%). Moreover, a novel heterozygous missense mutation in HNRNPA2B1 gene was identified in one male patient with isolated bone phenotype. As for other genetic factors, it was indicated that WNT16, RYR3, RYR1, NUP205, CAPN2 and NUP214 genes may be potential pathogenic genes, pathways of neurodegeneration and ALS may play a vital role in the pathogenesis of PDB.
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Affiliation(s)
- Xiaohui Tao
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Li Liu
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Xingguang Yang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Zhe Wei
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Zhongzhong Chen
- Department of Urology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ge Zhang
- Law Sau Fai Institute for Advancing Translational Medicine in Bone and Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China
- *Correspondence: Zhenlin Zhang, ; Ge Zhang, ; Hua Yue,
| | - Zhenlin Zhang
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Zhenlin Zhang, ; Ge Zhang, ; Hua Yue,
| | - Hua Yue
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Zhenlin Zhang, ; Ge Zhang, ; Hua Yue,
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Cardile C, Cazzaniga C, Mosca A, Ragni P. Total hip arthroplasty and Paget's disease: case report and literature review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022334. [PMID: 36533759 PMCID: PMC9828905 DOI: 10.23750/abm.v93i6.13426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/08/2022] [Indexed: 01/21/2023]
Abstract
Paget's disease (PDB) is a chronic osteopathy more common in male, Caucasic, European population, after the age of 50 years, that can lead to bone deformities. A challenging surgical solution for affected hip with severe hip osteoarthritis is total hip replacement (THA). We describe a case of THA in a 71-year-old patient with PDB and we present a literature review. In particular we find out that more studies comparing cementless THA with cemented one are necessary, in order to understand if one implant is better than the other.
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Affiliation(s)
- Carlo Cardile
- Section of Orthopedics and Trauma Surgery, ASST- Rhodense - Ospedale Salvini, Garbagnate Milanese, Milano (Italy)
| | - Carlo Cazzaniga
- Section of Orthopedics and Trauma Surgery, ASST- Rhodense - Ospedale Salvini, Garbagnate Milanese, Milano (Italy)
| | - Angelo Mosca
- Orthopedic Department, University of Milano-Bicocca, Ospedale San Gerardo, Monza (Italy)
| | - Paolo Ragni
- Section of Orthopedics and Trauma Surgery, ASST- Rhodense - Ospedale Salvini, Garbagnate Milanese, Milano (Italy)
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Zhukouskaya VV, Jauze L, Charles S, Leborgne C, Hilliquin S, Sadoine J, Slimani L, Baroukh B, van Wittenberghe L, Danièle N, Rajas F, Linglart A, Mingozzi F, Chaussain C, Bardet C, Ronzitti G. A novel therapeutic strategy for skeletal disorders: Proof of concept of gene therapy for X-linked hypophosphatemia. SCIENCE ADVANCES 2021; 7:eabj5018. [PMID: 34705504 PMCID: PMC8550245 DOI: 10.1126/sciadv.abj5018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
Adeno-associated virus (AAV) vectors are a well-established gene transfer approach for rare genetic diseases. Nonetheless, some tissues, such as bone, remain refractory to AAV. X-linked hypophosphatemia (XLH) is a rare skeletal disorder associated with increased levels of fibroblast growth factor 23 (FGF23), resulting in skeletal deformities and short stature. The conventional treatment for XLH, lifelong phosphate and active vitamin D analogs supplementation, partially improves quality of life and is associated with severe long-term side effects. Recently, a monoclonal antibody against FGF23 has been approved for XLH but remains a high-cost lifelong therapy. We developed a liver-targeting AAV vector to inhibit FGF23 signaling. We showed that hepatic expression of the C-terminal tail of FGF23 corrected skeletal manifestations and osteomalacia in a XLH mouse model. Our data provide proof of concept for AAV gene transfer to treat XLH, a prototypical bone disease, further expanding the use of this modality to treat skeletal disorders.
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Affiliation(s)
- Volha V. Zhukouskaya
- Genethon, 91000 Evry, France
- Université Paris-Saclay, Univ Evry, Inserm, Genethon, INTEGRARE Research Unit UMR_S951, 91000 Evry, France
- Université de Paris, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), Montrouge, France
- Paris-Saclay University, INSERM U1185, AP-HP, DMU SEA, Endocrinology and Diabetes for Children, Reference Center for Rare Diseases of the Calcium and Phosphate Metabolism, OSCAR filière, EndoRare, and BOND ERN, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Louisa Jauze
- Genethon, 91000 Evry, France
- Université Paris-Saclay, Univ Evry, Inserm, Genethon, INTEGRARE Research Unit UMR_S951, 91000 Evry, France
- Institut National de la Santé et de la Recherche Médicale, U1213, Lyon F-69008, France
| | - Séverine Charles
- Genethon, 91000 Evry, France
- Université Paris-Saclay, Univ Evry, Inserm, Genethon, INTEGRARE Research Unit UMR_S951, 91000 Evry, France
| | - Christian Leborgne
- Genethon, 91000 Evry, France
- Université Paris-Saclay, Univ Evry, Inserm, Genethon, INTEGRARE Research Unit UMR_S951, 91000 Evry, France
| | - Stéphane Hilliquin
- Université de Paris, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), Montrouge, France
- AP-HP, Department of Rheumatology, Cochin Hospital, Université de Paris, Paris, France
| | - Jérémy Sadoine
- Université de Paris, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), Montrouge, France
| | - Lotfi Slimani
- Université de Paris, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), Montrouge, France
| | - Brigitte Baroukh
- Université de Paris, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), Montrouge, France
| | | | | | - Fabienne Rajas
- Institut National de la Santé et de la Recherche Médicale, U1213, Lyon F-69008, France
| | - Agnès Linglart
- Paris-Saclay University, INSERM U1185, AP-HP, DMU SEA, Endocrinology and Diabetes for Children, Reference Center for Rare Diseases of the Calcium and Phosphate Metabolism, OSCAR filière, EndoRare, and BOND ERN, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Federico Mingozzi
- Genethon, 91000 Evry, France
- Université Paris-Saclay, Univ Evry, Inserm, Genethon, INTEGRARE Research Unit UMR_S951, 91000 Evry, France
| | - Catherine Chaussain
- Université de Paris, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), Montrouge, France
- Paris-Saclay University, INSERM U1185, AP-HP, DMU SEA, Endocrinology and Diabetes for Children, Reference Center for Rare Diseases of the Calcium and Phosphate Metabolism, OSCAR filière, EndoRare, and BOND ERN, Bicêtre Hospital, Le Kremlin-Bicêtre, France
- AP-HP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Dental Medicine Department, Bretonneau Hospital, GHN-Université de Paris, Paris 75018, France
| | - Claire Bardet
- Université de Paris, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), Montrouge, France
| | - Giuseppe Ronzitti
- Genethon, 91000 Evry, France
- Université Paris-Saclay, Univ Evry, Inserm, Genethon, INTEGRARE Research Unit UMR_S951, 91000 Evry, France
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Medication Management of Selected Pathological Jaw Lesions. Oral Maxillofac Surg Clin North Am 2021; 34:179-187. [PMID: 34602322 DOI: 10.1016/j.coms.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Most jaw lesions are treated surgically. Areas of abnormal proliferation or destruction in bone are commonly treated by regional curettage, excision, or resection. However, surgery is invasive and leaves a defect where the lesion was removed. Surgical trauma to adjacent healthy tissue, including vital neurovascular bundles is often unavoidable, and can be especially traumatizing to the pediatric patient. Select jaw lesions with well-studied nonsurgical pharmaceutical treatments are presented here.
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Barale M, Sigrist S, Bioletto F, Maiorino F, Ghigo E, Mazzetti R, Procopio M. Long-Term Efficacy of Intensive Zoledronate Therapy and Predictors of Retreatment in Paget's Disease of Bone. Calcif Tissue Int 2021; 109:383-392. [PMID: 33876253 PMCID: PMC8429167 DOI: 10.1007/s00223-021-00848-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/31/2021] [Indexed: 11/03/2022]
Abstract
Despite the current debate on the best therapeutic approach, i.e. symptomatic vs intensive strategy, one zoledronate (Zol) infusion is effective in most patients with Paget's disease of bone (PDB), whereas few need retreatment, whose predictors are not well established. We aimed to evaluate long-term efficacy of intensive Zol therapy and predictors of retreatment in PDB. Pagetic complications, clinical and biochemical response to Zol together with frequency of retreatment were retrospectively assessed in forty-seven PDB patients (age, mean ± SD: 72.5 ± 8.9 years, M/F: 24/23; symptomatic/asymptomatic: 16/31). Statistical analysis for retreatment prediction were based on Mann-Whitney U test, Pearson's Χ2 and ROC curve analysis. During seven-year follow-up, all patients achieved pain relief and only one underwent arthroplasty. Bone alkaline phosphatase (BAP) detected three non-responder (6%) and six relapsing (13%) patients needing retreatment. Retreated patients had less old age (66.1 ± 11.2 vs 74.0 ± 7.7 years), higher frequency of polyostotic disease (78% vs 40%) and higher baseline (96.5 ± 24.8 vs 44.9 ± 27.7 mcg/l) and post-Zol nadir BAP levels (24.7 ± 24.1 vs 8.1 ± 4.1 mcg/l) than patients treated once (p < 0.05 for all comparisons). In multivariate analysis both serum baseline and post-Zol nadir BAP significantly predicted retreatment (OR 1.09, 95%CI 1.01-1.17 and 1.29, 1.03-1.62, respectively), with ROC curve analysis showing the greatest accuracies for threshold values of 75.6 and 9.9 mcg/l (sensitivity 88 and 90%, specificity 94 and 86%, AUC 0.92 and 0.93, respectively). Our data in mostly asymptomatic, metabolically active PDB patients treated with intensive Zol therapy show a negligible incidence of pagetic complications and long-term optimal disease control, with BAP being the best predictor of retreatment.
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Affiliation(s)
- Marco Barale
- Division of Endocrinology, Department of General and Specialty Medicine, Diabetology and Metabolic Diseases, Molinette Hospital, University of Turin, Cso Dogliotti, 14, 10126, Turin, Italy.
| | - Sarah Sigrist
- Division of Endocrinology, Diabetology, Osteology and Metabolic Diseases, Kantonsspital St.Gallen, Rorschacher Strasse, 95, 9007, St.Gallen, CH, Switzerland
| | - Fabio Bioletto
- Division of Endocrinology, Department of General and Specialty Medicine, Diabetology and Metabolic Diseases, Molinette Hospital, University of Turin, Cso Dogliotti, 14, 10126, Turin, Italy
| | - Federica Maiorino
- Division of Endocrinology, Department of General and Specialty Medicine, Diabetology and Metabolic Diseases, Molinette Hospital, University of Turin, Cso Dogliotti, 14, 10126, Turin, Italy
| | - Ezio Ghigo
- Division of Endocrinology, Department of General and Specialty Medicine, Diabetology and Metabolic Diseases, Molinette Hospital, University of Turin, Cso Dogliotti, 14, 10126, Turin, Italy
| | - Riccardo Mazzetti
- Radiology Unit, Department of Diagnostic Imaging and Interventional Radiology, Molinette Hospital, University of Turin, Cso Dogliotti, 14, 10126, Turin, Italy
| | - Massimo Procopio
- Division of Endocrinology, Department of General and Specialty Medicine, Diabetology and Metabolic Diseases, Molinette Hospital, University of Turin, Cso Dogliotti, 14, 10126, Turin, Italy
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Gogas Yavuz D, Aytürk S, Çetinkalp Ş, Bayraktar F, Kulaksızoğlu M, Hekimsoy Z, Aydın H, Uygur M, Deniz F, İpekçi S, Atmaca A, Saraç F, Özdemir N, Cantürk Z, Mert M, Sancak S, Ertörer E, Duran C, Akarsu E, Deyneli O, Selek A, Gürlek A. Clinical and demographic aspects of Paget disease of bone: A multicentric study from Turkey. Eur J Rheumatol 2021; 8:156-161. [PMID: 33284101 PMCID: PMC9770406 DOI: 10.5152/eurjrheum.2020.20139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Paget disease of bone (PDB) is a metabolic bone disease that has been rarely reported in the Eastern countries. This study aimed to evaluate the clinical and demographic characteristics of patients with PDB followed up at endocrinology clinics in Turkey. METHODS An invitation was sent to tertiary endocrinology clinics to complete a survey on the demographic, clinical, radiological, and laboratory parameters, as well as treatment modalities of patients with PDB. This study enrolled clinically and radiologically proven 185 patients with PDB from 18 endocrinology centers based in 10 cities of Turkey. RESULTS This cohort of PDB had female preponderance (women/men: 105/80) with a mean age, during diagnosis, of 57±10 years. Most of the patients (59.6%) were symptomatic at diagnosis. Bone pain and headache were the predominant clinical symptoms. Polyostotic disease was observed in 67.5% (n=125) of patients. Frequently affected bones were skull (41.6%), pelvis (53.5%), spine (41%), and femur (25.4%). Moreover, 17 patients with skull involvement had hearing loss. Mean serum alkaline phosphatase (ALP) level (552±652 IU/L; range: 280-5762 IU/L) was over the normal reference cutoff with normal serum calcium levels. Intravenous bisphosphonates (zoledronic acid, 5 mg; pamidronate, 60-90 mg) were the most used drugs (75%) for the treatment of PDB. Most of the patients (87.1%) treated with intravenous bisphosphonates responded well, with a decrease in serum ALP level (117±114 IU/L) in the 12th month of therapy. Furthermore, 16 patients relapsed after the second year of therapy; 3 patients did not respond to the initial intravenous bisphosphonate treatment. CONCLUSION The patients with PDB followed up by endocrinology clinics of Turkey exhibited polyostotic disease with classical clinical, radiological, and biochemical features and women's predominance with good response to intravenous bisphosphonate therapy.
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Affiliation(s)
- Dilek Gogas Yavuz
- Department of Endocrinology and Metabolism, Marmara University School of Medicine, İstanbul,
Turkey
| | - Semra Aytürk
- Department of Endocrinology and Metabolism, Trakya University School of Medicine, Edirne,
Turkey
| | - Şevki Çetinkalp
- Department of Endocrinology and Metabolism, Ege University School of Medicine, İzmir,
Turkey
| | - Fırat Bayraktar
- Department of Endocrinology and Metabolism, Dokuz Eylül University School of Medicine, İzmir,
Turkey
| | - Mustafa Kulaksızoğlu
- Department of Endocrinology and Metabolism, Necmettin Erbakan University School of Medicine, Konya,
Turkey
| | - Zeliha Hekimsoy
- Department of Endocrinology and Metabolism, Celal Bayar University School of Medicine, Manisa,
Turkey
| | - Hasan Aydın
- Department of Endocrinology and Metabolism, Yeditepe University School of Medicine, İstanbul,
Turkey
| | - Melin Uygur
- Department of Endocrinology and Metabolism, Yeni Yuzyıl University School of Medicine, İstanbul,
Turkey
| | - Ferhat Deniz
- Department of Endocrinology and Metabolism, Health Sciences University School of Medicine, Abdulhamid Han Hospital, İstanbul,
Turkey
| | - Süleyman İpekçi
- Department of Endocrinology and Metabolism, Selçuk University School of Medicine, Konya,
Turkey
| | - Ayşegül Atmaca
- Department of Endocrinology and Metabolism, Ondokuz Mayıs University School of Medicine, Samsun,
Turkey
| | - Fulden Saraç
- Department of Geriatrics, İzmir Ege University School of Medicine, İzmir,
Turkey
| | - Nilüfer Özdemir
- Department of Endocrinology and Metabolism, Celal Bayar University School of Medicine, Manisa,
Turkey
| | - Zeynep Cantürk
- Department of Endocrinology and Metabolism, Kocaeli University School of Medicine, Kocaeli,
Turkey
| | - Meral Mert
- Department of Endocrinology and Metabolism, Health Sciences University School of Medicine, Sadi Konuk Hospital, İstanbul,
Turkey
| | - Seda Sancak
- Department of Endocrinology and Metabolism, Health Sciences University School of Medicine, Fatih Sultan Mehmet Hospital, İstanbul,
Turkey
| | - Eda Ertörer
- Department of Endocrinology and Metabolism, Başkent University School of Medicine, Adana Hospital, Adana,
Turkey
| | - Cevdet Duran
- Department of Endocrinology and Metabolism, Uşak University School of Medicine, Uşak,
Turkey
| | - Ersin Akarsu
- Department of Endocrinology and Metabolism, Gaziantep University School of Medicine, Gaziantep,
Turkey
| | - Oğuzhan Deyneli
- Department of Endocrinology and Metabolism, Koç University School of Medicine, İstanbul,
Turkey
| | - Alev Selek
- Department of Endocrinology and Metabolism, Kocaeli University School of Medicine, Kocaeli,
Turkey
| | - Alper Gürlek
- Hacettepe University Faculty of Medicine Section of Endocrinology and Metabolism, Ankara,
Turkey
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Abstract
PURPOSE OF REVIEW To provide an overview of the role of genes and loci that predispose to Paget's disease of bone and related disorders. RECENT FINDINGS Studies over the past ten years have seen major advances in knowledge on the role of genetic factors in Paget's disease of bone (PDB). Genome wide association studies have identified six loci that predispose to the disease whereas family based studies have identified a further eight genes that cause PDB. This brings the total number of genes and loci implicated in PDB to fourteen. Emerging evidence has shown that a number of these genes also predispose to multisystem proteinopathy syndromes where PDB is accompanied by neurodegeneration and myopathy due to the accumulation of abnormal protein aggregates, emphasising the importance of defects in autophagy in the pathogenesis of PDB. Genetic factors play a key role in the pathogenesis of PDB and the studies in this area have identified several genes previously not suspected to play a role in bone metabolism. Genetic testing coupled to targeted therapeutic intervention is being explored as a way of halting disease progression and improving outcome before irreversible skeletal damage has occurred.
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Affiliation(s)
- Navnit S Makaram
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Stuart H Ralston
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, EH4 2XU, UK.
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Nepal S, Jarusriwanna A, Unnanuntana A. Stress Fracture of the Femoral Shaft in Paget's Disease of Bone: A Case Report. J Bone Metab 2021; 28:171-178. [PMID: 34130369 PMCID: PMC8206614 DOI: 10.11005/jbm.2021.28.2.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/19/2021] [Indexed: 11/12/2022] Open
Abstract
Paget’s disease of bone (PDB) is a progressive bone disorder characterized by increased osteoclast-mediated bone resorption and abnormal bone formation. Incomplete atypical femoral fracture, appearing radiographically as a stress fracture at the lateral aspect of the femur, is an uncommon low-trauma fracture frequently seen in association with long-term bisphosphonate therapy. We describe the case of a 61-year-old female patient with PDB who developed a stress fracture at the lateral femoral cortex after 5 doses of intravenous bisphosphonate. The conservative treatment plan included discontinuation of bisphosphonate, a continuation of calcium and vitamin D supplementation, and limited weight-bearing for 3 months. The patient’s pain level gradually improved after switching to the new treatment plan. At the latest follow-up, approximately 5 years after the initiation of conservative treatment, the patient remained pain-free, and her PDB was well-controlled. However, the fracture line was still visible on the most recent radiograph. Although it remains unclear whether a stress fracture at the lateral femoral cortex occurred due to bisphosphonate therapy or PDB, this case highlights the importance of careful evaluation of any lesion that appears in PDB patients receiving bisphosphonate therapy.
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Affiliation(s)
- Sarthak Nepal
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Atthakorn Jarusriwanna
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Aasis Unnanuntana
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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47
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Miao XY, Wang XL, Lyu ZH, Ba JM, Pei Y, Dou JT, Gu WJ, Du J, Guo QH, Chen K, Mu YM. Paget’s disease of bone: Report of 11 cases. World J Clin Cases 2021; 9:3478-3486. [PMID: 34002161 PMCID: PMC8107896 DOI: 10.12998/wjcc.v9.i14.3478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/02/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Paget’s disease of bone (PDB) is a rare metabolic bone disease in China and is characterized by increased bone resorption and disorganized bone formation. The main clinical symptoms of PDB are focal or multiple bone pain and deformity with high disability. The disease has high missed diagnosis and misdiagnosis rates. This report summarizes the clinical manifestations, imaging and pathological features, and treatments of 11 patients with PDB at our hospital from 1993 to 2020 in order to improve the recognition and prognosis of PDB.
CASE SUMMARY There were eight male and three female patients whose average age was 48.7 ± 11.0 years with a PDB course of 1-16 years. Nine patients had bone pain and bone deformities in different parts of the body, the majority of which involved the long bones. Laboratory examinations revealed elevated serum alkaline phosphatase (ALP) in all patients with an average of 618 ± 460 IU/L (normal range 0-130 IU/L), and serum calcium and phosphorus levels were in the normal range. Imageology showed that osteolysis was usually combined with osteosclerosis and/or bone deformities in single or multiple bones. 99mTc-methylene diphosphonate bone scintigraphy revealed increased radionuclide uptake in the bone lesions. Six patients underwent bone tissue biopsy, and the typical pathological changes were a mosaic structure of the bone trabeculae with irregularly arranged cement lines and multinuclear osteoclasts. Ten of the 11 patients were effectively treated with bisphosphonates.
CONCLUSION Early diagnosis of the rare disease PDB can be made through elevated ALP levels and typical presentations on bone X-ray and from bone tissue biopsy.
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Affiliation(s)
- Xin-Yu Miao
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Xian-Ling Wang
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhao-Hui Lyu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Jian-Ming Ba
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Yu Pei
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Jing-Tao Dou
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Wei-Jun Gu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Jin Du
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Qing-Hua Guo
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Kang Chen
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Yi-Ming Mu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
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48
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Diboun I, Wani S, Ralston SH, Albagha OM. Epigenetic analysis of Paget's disease of bone identifies differentially methylated loci that predict disease status. eLife 2021; 10:65715. [PMID: 33929316 PMCID: PMC8184208 DOI: 10.7554/elife.65715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/29/2021] [Indexed: 12/13/2022] Open
Abstract
Paget's disease of bone (PDB) is characterized by focal increases in disorganized bone remodeling. This study aims to characterize PDB-associated changes in DNA methylation profiles in patients' blood. Meta-analysis of data from the discovery and cross-validation set, each comprising 116 PDB cases and 130 controls, revealed significant differences in DNA methylation at 14 CpG sites, 4 CpG islands, and 6 gene-body regions. These loci, including two characterized as functional through expression quantitative trait-methylation analysis, were associated with functions related to osteoclast differentiation, mechanical loading, immune function, and viral infection. A multivariate classifier based on discovery samples was found to discriminate PDB cases and controls from the cross-validation with a sensitivity of 0.84, specificity of 0.81, and an area under curve of 92.8%. In conclusion, this study has shown for the first time that epigenetic factors contribute to the pathogenesis of PDB and may offer diagnostic markers for prediction of the disease.
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Affiliation(s)
- Ilhame Diboun
- Division of Genomic and Translational Biomedicine, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Sachin Wani
- Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Stuart H Ralston
- Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Omar Me Albagha
- Division of Genomic and Translational Biomedicine, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar.,Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
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49
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Paget's Disease of Bone: Osteoimmunology and Osteoclast Pathology. Curr Allergy Asthma Rep 2021; 21:23. [PMID: 33768371 DOI: 10.1007/s11882-021-01001-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to recognize clinical features of Paget's disease of bone and to describe how the osteoclast, a myeloid-derived cell responsible for bone resorption, contributes to the disease. RECENT FINDINGS Recent studies have identified several variants in SQSTM1, OPTN, and other genes that may predispose individuals to Paget's disease of bone; studies of these genes and their protein products have elucidated new roles for these proteins in bone physiology. Understanding the pathologic mechanisms in the Pagetic osteoclast may lead to the identification of future treatment targets for other inflammatory and autoimmune diseases characterized by abnormal bone erosion and/or osteoclast activation.
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Raad M, Ndlovu S, Hǿgsand T, Ahmed S, Norris M. Fracture of tibial tuberosity in an adult with Paget's disease of the bone - An interesting case and review of literature. Trauma Case Rep 2021; 32:100440. [PMID: 33681443 PMCID: PMC7930319 DOI: 10.1016/j.tcr.2021.100440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Paget's disease of the bone is a non-malignant skeletal disorder characterized by focal abnormalities in bone remodelling at one or more skeletal sites. Pathological fractures occurring from trivial injuries are a well-known clinical presentation in patients with Paget's disease. An avulsion fracture of the tibial tuberosity is an infrequent injury and has an extremely low occurrence in adults, with only a few cases reported in literature. We describe a case of a patient with undiagnosed Paget's Disease of the bone, sustaining a pathological avulsion fracture of the tibial tuberosity. Case report A 54-year-old male presented with right knee pain after his knee gave way whilst standing in the goal area during a game of football, twisting his right ankle and falling. Plain radiographs of the knee revealed an avulsion fracture of the tibial tuberosity with abnormal modelling of the proximal half of the tibia. An MRI confirmed a diagnosis of Paget's disease of the bone. The patient underwent open reduction internal fixation. At 3 months follow up, the patient had good knee range of motion from 0 to 100 degrees and by 6 months he had returned to his usual activities. Conclusion We describe a unique case of tibial tuberosity avulsion fracture in an adult with PDB. Treatment was successful with cannulated screws and tension band wiring. Patients with PDB who fracture present with diagnostic and operative challenges, it is vital to progress with caution in the postoperative rehabilitation phase.
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Affiliation(s)
- Marjan Raad
- Department of Trauma and Orthopaedic Surgery, Darent Valley Hospital, Darenth Wood Road, Dartford, Kent DA2 8DA, United Kingdom of Great Britain and Northern Ireland
| | - Sebastian Ndlovu
- Department of Trauma and Orthopaedic Surgery, Darent Valley Hospital, Darenth Wood Road, Dartford, Kent DA2 8DA, United Kingdom of Great Britain and Northern Ireland
| | - Tord Hǿgsand
- Department of Trauma and Orthopaedic Surgery, Darent Valley Hospital, Darenth Wood Road, Dartford, Kent DA2 8DA, United Kingdom of Great Britain and Northern Ireland
| | - Saif Ahmed
- Department of Trauma and Orthopaedic Surgery, Darent Valley Hospital, Darenth Wood Road, Dartford, Kent DA2 8DA, United Kingdom of Great Britain and Northern Ireland
| | - Mark Norris
- Department of Trauma and Orthopaedic Surgery, Darent Valley Hospital, Darenth Wood Road, Dartford, Kent DA2 8DA, United Kingdom of Great Britain and Northern Ireland
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